Winning the highly coveted National Quality Healthcare Award from the National Quality Forum is something to which many organizations aspire but few actually succeed in accomplishing. It requires sustained focus and determination on delivering patients the best possible clinical outcomes and providing exceptional patient care. The 2009 recipient of the National Quality Healthcare Award, Memorial Hermann Healthcare System, which serves the greater Houston, Texas community, added this prestigious award to an already overflowing trophy case.

Accomplished and compassionate doctors, skilled surgeons, exceptional nurses, and outstanding pharmacists are just several pieces to the larger organizational puzzle that makes such awards possible. David Bradshaw, Memorial Hermann’s chief information, planning, and marketing officer, argues that IT plays a critical role in driving organizational quality.

“Our IT challenge in healthcare is to document information under a common vocabulary that enables us to deliver great patient care,” Bradshaw says. “The biggest opportunities that we’re seeing is when we start to look across multiple patients, whether it is for direct evidence-based protocols to deliver better outcomes or to measure and show visibility to our processes. The truly sustainable quality improvements come about from the aggregation of and reporting on this transactional data.”

A long way since Y2K

When Bradshaw assumed charge as the CIO at Memorial Hermann in 1997, the challenges confronting the Information Systems Department (ISD) were dramatically different than the ones facing the organization today. A not-for-profit approximately one-third its current size, Memorial Hermann was focused on Y2K issues.

“Getting through Y2K with very little impact was a key success for the IT organization,” Bradshaw recalls. With Y2K behind them and the arrival of a new president and CEO, Dan Wolterman, Bradshaw and his team intertwined technology with the business. This included having Wolterman “as the executive sponsor for many of our IT initiatives,” Bradshaw explains. The team made a conscientious decision in 2001 to become very aggressive with its IT investments, and these have “positioned Memorial Hermann to create solutions that its competitors cannot replicate.”

The nature of the IT challenges have become larger in nature and scope. “The size and speed of the network, the data stores, and the need to always be on from a computing infrastructure standpoint have grown exponentially,” Bradshaw says. “Healthcare is a 24×7 operation, and there is simply no tolerance for downtime any longer.”

A “whammy” of challenges

Bradshaw divides the business drivers in healthcare into two buckets. “There is the clinical half, which is typically up on a floor with a doctor, with a patient, with a nurse,” Bradshaw notes. “The challenge is to document all of the data they are creating, safely store it in an appropriate location, and then mine the data from a quality and outcome standpoint.” The second component is associated with the revenue cycle, insurance payouts, and identification of the ultimate payment for the services rendered.

The current economic crisis, coupled with the effects of Hurricane Ike that resulted in the closure of a level-one trauma center, is creating significant challenges for Memorial Hermann. Bradshaw explains that these two turn into a “triple whammy” when the uninsured problem is factored into the equation. “Houston is the epicenter of the uninsured problem,” Bradshaw says. “One in three people have no insurance. This situation is exacerbated by the economic crisis.” As a result, the IT organization has become “more streamlined and focused on delivering value” in order to address these issues.

Organizing and managing all of the pieces

The CIO has a unique opportunity in many organizations today. “CIOs bring a skill set of methodical thinking,” Bradshaw explains. “The ability to drive toward milestones and outcomes creates more accountability on delivering the IT infrastructure to the business units.”

For-profits and not-for-profits alike are recognizing the man-agement faculties of their CIOs and giving them additional executive roles and responsibilities. Bradshaw, who was named chief marketing officer in 2004 and then chief planning officer in 2006, is one such example. Notwithstanding, in order to juggle these additional responsibilities, he heavily relies on three ISD system executives to help drive strategic direction and manage day-to-day functions: Carol DeNeefe for Network Solutions; Amanda Hammel for Technical Services; and Emily Handwerk for Applications. “As I spend only 40 percent of my time in the ‘ISD world’, the teamwork between the four of us is critical to success,” Bradshaw contends.

The bulk of Bradshaw’s time is spent on strategic planning and the prioritization of new IT initiatives. “We rack and stack all of our projects,” he says. “We draw a line and indicate which projects can be funded and which cannot. We must then manage the infrastructure of people, networks, and technologies required to complete each of these projects.”

Supporting an organization the breadth and size of Memorial Hermann, which has more than 20,000 employees and over 90 different facilities, requires close-knit IT integration with the business owners. As such, Bradshaw and his ISD management team have assigned IT relationship managers to each business unit. They are expected to become business domain experts, understanding the requirements of the business unit to which they are assigned as well or better than the business owners themselves. “These individuals serve as the conduit to their assigned business unit, helping to translate business requirements into technology solutions,” Bradshaw explains. “They in effect serve as a member of that local management team.”

Having the right technology tools in place to manage the vast expanses of its IT infrastructure is an important lynchpin in Memorial Hermann’s quest to maintain a healthy IT environment. “We have several strategic suppliers,” Bradshaw notes, “and Symantec is one of them.”

A cure for data protection

For protecting data on its Microsoft Windows-based server environment, Memorial Hermann implemented Symantec Backup Exec about 10 years ago. As its environment grew in complexity and backup and data volumes expanded, the ISD team moved to Veritas NetBackup. Then, last year, the team upgraded to the latest version of NetBackup.

The ISD team backs up nearly 80 terabytes of data each week, and backup success rates exceed 99 percent. Prior to standardizing backup and restore on NetBackup, one FTE spent several hours each day troubleshooting backup failures; this has been reduced to a few minutes of monitoring the backup console.

In addition to the above, the next-generation backup-and-restore environment provides Memorial Hermann with various operational efficiencies, including rapid scale—nearly 15 percent annual growth in backup volumes over the past five years—and labor cost avoidance through operational efficiencies.

The NetBackup upgrade last year included the addition of Media Server Encryption Option. “We needed to address governmental regulations around security and privacy,” Bradshaw says. “The expanded solution allows the ISD team to safeguard confidential patient and billing information stored on tapes while in transit.”

Sterilizing the mail

Mail security is another issue Bradshaw and his team has tackled. Several years ago, end users were being overwhelmed with incoming spam, and the number of virus outbreaks from email was growing in leaps and bounds. “There was an outcry,” DeNeefe recalls. “We wanted to take some bold steps, and we looked at two different solutions, ultimately selecting Symantec Brightmail Gateway.”

Since deploying Brightmail Gateway, the issues of mail security have only become more challenging. “We get approximately 12 million pieces of mail each month,” Marc Packard, the director of network solutions at Memorial Hermann, reports. “The Brightmail solution filters out anywhere between 60 percent and 90 percent of all email.” The results of the solution translate across the organization. First, the number of malicious code intrusions resulting from email is dramatically lower; benefits cascade from end users to the ISD team, both of which translate into better patient care and services. Second, end users no longer need to spend valuable time going through all of their email and cleaning it; hospital staff can focus on delivering better patient care and services. Finally, the ISD team filters out approximately 200 gigabytes of incoming spam each month, equating to about $36,000 in annual storage savings.

Caring for all those endpoints

The Memorial Hermann IT environment is vast, with more than 1,100 data center servers and approximately 18,000 endpoints on the client—and recent growth has been exponential. “The number of workstations on our network grew at a compounded annual rate of almost 15 percent over the past six years,” Bradshaw reports, “and we see no end really in sight for that growth. As we know that we cannot grow the FTE numbers at the same rate as the growth rate of devices in our environment, we need a solution that provides us with the means to drive operational efficiencies.”

In 2004, the Memorial Hermann ISD team conducted an RFP and opted to standardize on the Altiris Endpoint Management solution from Symantec as the basis. For management of the endpoint on the client, they use Altiris Client Management Suite. Systems covered include desktops, laptops, and wireless PCs on wheels (WOWs). For management of their data center servers, the team relies on Altiris Server Management Suite.

The ISD team instituted aggressive service level agreements for deployment of security updates when they integrated the Altiris Endpoint Management solution. Prior to deploying the Altiris solution, the ISD team was hard pressed to achieve an 80 percent success rate. However, with Altiris, the team has been able to drive the ratio to 98 percent or better, and this is accomplished within a first-run pass. “We’re able to get critical security patches deployed within a two-week timeframe, and within 72 hours in the case of the DMZ,” DeNeefe says.

To streamline provisioning of equipment, major updates, and refreshes, the ISD team also leverages Altiris, imaging desktops, laptops, WOWs, and data center servers—including pushing specific application packages. “I cannot imagine trying to manage our environment without a tool such as Altiris,” DeNeefe says. “It really improved the productivity of our staff.

The before-and-after picture is dramatic. For the imaging or reimaging of one client, it previously required one FTE more than one hour. With the Altiris solution, that same FTE is able to image or reimage multiple clients, all within 15 to 20 minutes. In the case of data center servers, the results are even more impressive; it took one FTE nearly a day to provision a new or existing server. Now, with the Altiris solution, that same FTE is able to complete the imaging the multiple servers within 15 to 20 minutes.

Quality becomes evident during the challenge

The ability of an organization to drive quality is most evident during challenging times, and Bradshaw and his team have experienced their share over the past decade. When Tropical Storm Allison dumped 40 inches of rainfall into the Houston area in 2001, Memorial Hermann’s “primary data center at that time was below grade, and we had to close it for two days,” Bradshaw remembers. “We emptied our Texas Medical Center hospital, doctors, nurses, pharmacists, and patients, dispersing all of them into different hospitals not affected by the flood waters.” In 2005, when Hurricane Katrina devastated the New Orleans area, a Life Flight crew from Memorial Hermann evacuated the first patient from the Ochsner Health System.

“Being there during times of challenge is simply the fabric of Memorial Hermann,” Bradshaw concludes. “When a disaster comes, we’re there to respond and provide solutions.” And having the right IT infrastructure tools in place is an important piece to the larger puzzle that enables award-winning Memorial Hermann to provide exception patient care.

Patrick E. Spencer (Ph.D.) is the editor in chief for CIO Digest and the author of a book and various articles and reviews published by Continuum Books and Sage Publications, among others.